Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2023
Observational StudyPost-total joint arthroplasty opioid prescribing practices vary widely and are not associated with opioid refill: an observational cohort study.
Optimized health system approaches to improving guideline-congruent care require evaluation of multilevel factors associated with prescribing practices and outcomes after total knee and hip arthroplasty. ⋯ In the present study, several patient-, care-, and hospital-level factors were associated with an increased probability of an opioid prescription refill within 30 days after arthroplasty. Future work is needed to identify optimal approaches to reduce unwarranted and inequitable healthcare variation within a patient-centered framework.
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Arch Orthop Trauma Surg · Sep 2023
Computed tomography arthrography versus magnetic resonance imaging for diagnosis of osteochondral lesions of the talus.
Osteochondral lesions of the talus (OLT) usually have non-specific clinical symptoms, and radiographs have a low sensitivity for detecting OLT. The purpose of this study is to compare the diagnostic value of CT arthrography (CTa) with that of MRI using arthroscopy as the reference standard for grading OLT. ⋯ Diagnostic Level III.
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Arch Orthop Trauma Surg · Sep 2023
"Koehlers teardrop is not a reliable landmark for assessing the centre of rotation after Total hip arthroplasty" - a retrospective radiological study.
Various anatomical landmarks have become established in radiography for the assessment of cup positioning after total hip arthroplasty (THA). The most important one is Koehler's teardrop figure (KTF). However, there is a lack of data on the validity of this landmark, which is widely used clinically for assessing the centre of rotation of the hip. ⋯ The KTF is not a sufficiently valid landmark for assessing the centre of rotation after THA. It is influenced by many different disturbance variables. However, it is largely robust against changes in pelvic tilt, so that it can be used as a reference point when comparing different intraindividual radiographs to assess the change in the centre of rotation due to implantation or to detect cup migration.
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Arch Orthop Trauma Surg · Sep 2023
Lowest instrumented vertebrae selection in posterior fusion of Lenke 3C/6C adolescent idiopathic scoliosis: L3 versus L4, when LEV is L4.
In structural thoracolumbar/lumbar (TL/L) curves, lowest instrumented vertebra is selected mostly as the lower end vertebra (LEV). To save more lumbar mobile segments, fusion may be stopped one level proximal. This study aimed to compare the radiologic and functional outcomes of Lenke type 3C and 6C adolescent idiopathic scoliosis patients according to distal fusion level. ⋯ In TL/L curves which have L4 as LEV, satisfactory results can be achieved with stopping the fusion at L3, if a proper disc alignment below LIV can be obtained intraoperatively. Higher amount of LIV disc angle in L3 group did not cause coronal and sagittal imbalance. Although clinical outcomes are similar with stopping at L3 or L4, fusion to L3 may be prefered to save one more mobile disc.
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Arch Orthop Trauma Surg · Sep 2023
Extension osteotomy of the metacarpal I and ligamentoplasty of the trapeziometacarpal joint for the treatment of early-stage osteoarthritis and instability of the trapeziometacarpal joint.
Osteoarthritis (OA) is a common disease of the first carpo-metacarpal (CMC I) joint. Biomechanical factors promoting OA are the shape of the CMC I-joint, being a biconcave-convex saddle joint with high mobility and the increased instability caused by joint space narrowing, ligamentous laxity, and direction of force transmission of the abductor pollicis longus (APL) tendon during adduction. ⋯ We combine this closing wedge osteotomy with a ligamentoplasty to stabilize the joint. In this manuscript, we provide a detailed description of the indication, discuss biomechanical aspects and the surgical technique in detail.